Medical Wastes recycled at deadly risk

Needles and syringes are for one time use only and after using these are to be discarded for good. But it appears that this rule is not being widely upheld in the country. Reports appeared in newspapers that some merchants of death consider it a good business to collect used syringes and needles at very little or no price. After collecting them in adequate number, the syringes and needles are wrappedup in fresh packages.

The same is done so expertly that the deceit can be hardly detected. the used needles are successfully marketed and end up for mass use at doctors' chambers, private clinics and other places. The reputed facilities for treatment in the country probably take care not to buy such hazardous things. But most of the others-and these are much more in number-do not hesitate to use them out of a consideration that these are substantially cheaper than the new ones. Thus, syringes and needles that had been used to draw the infected bloods of patients with AIDs, Hepatitis B and other very dangerous diseases, are reused on unsuspecting persons who can be, thus, infected by the same diseases (The New Nation, January 09, 2004
).

Despite warnings from national and international bodies, most hospitals, clinics and diagnostic centres continue to dump their wastes in the open, exposing people to serious health hazards.
Hospital wastes like throwaway syringes, saline bags, slides, bottles and gauze are also dumped in the water-bodies of the city including Dhanmondi lake.
"Indiscriminate disposal of wastes can spread diseases like AIDS," cautioned Monzurul Hannan Khan, director of the International Union for Conservation of Nature (IUCN) of Bangladesh.

The diseases can spread epidemically, if the trend to recycle used materials continues in this manner, the IUCN director said.
"We requested the health and environment ministries to cancel the licences of hospitals, clinics and diagnostic centres that are not properly disposing of wastes," said Khan.
"We found that there was no waste disposal policy. The allegation is that the persons who are responsible for disposal of wastes sell it to some traders instead of burning it," he said.

"We have repeatedly requested the ministries to take urgent steps to prevent indiscriminate disposal of highly toxic clinical wastes, but to no avail," said Khan.
Environment and Forest Minister Shahjahan Siraj said, "We formed a committee at a meeting last month to prepare a guideline for waste disposal by the clinics, hospitals and diagnostic centres."
Street children collect hospital wastes from dustbins and sell it mostly to the traders in Siddique Bazar and Zinzira.

"We have a project at Ashulia where we burn wastes," said Customer Service Manager of Lab Aid Masumul Haque.
Sources said no-one manages wastes properly and the hospitals and clinics dump it in dustbins.
The traders of Siddique Bazar send used syringes to Zinzira where they wash them with Buriganga water and pack them in polythene to make them fit for resale.

A trader at Siddique Bazar said the chemists working in upazilas and districts purchase a sack of syringes at Tk 150. "Many chemists opt for these cheaper, recycled items as the new items are expensive," he said.
(Source: The Daily Star, September 17, 2003)

Hospital Waste

Heaps of putrefying garbage lying by the roadside or bulging out of a dustbin is a common sight in Bangladesh. Pedestrians avoid the foul-smelling mass by walking as far away from it as possible. But if you are the adventurous sort, and have the nerve to take a closer look, you will discover a more frightening fact. Lurking in the heap are bloody syringes, soiled bandages, used needles-all kinds of items from hospitals.

These are not ordinary domestic waste. They are highly infectious and hazardous. They may carry the germs of dreaded diseases like hepatitis (jaundice), and HIV/AIDS. Mixed with the ordinary waste, they make the entire pile a great public health hazard. To make matters worse, poor scavengers (tokais) rummage though the pile, earnestly searching for saleable items like syringes. These are collected, washed, repacked and resold to the public. Thus the vicious cycle of transmission continues

The prevalence of diseases that may be transmitted by hospital waste is alarming in Bangladesh. There is evidence of hepatitis B infection among 10 children (5-10 years old) and 30 adults. About 5 of our total population is thought to suffer from chronic hepatitis B infection [1]. Although cases of HIV/AIDS is low in Bangladesh (only about 13,000 cases estimated in 2001) in comparison to neighbouring countries, nevertheless the numbers are rising [2]. Reuse of infected syringes is a potential risk in spreading this disease.

Hospital waste accounts for a very small fraction of the total waste generated in a city. It is estimated that in Bangladesh only about 1 of the total solid waste originates from hospitals. Moreover, only 10-25 of the hospital wastes are infectious or hazardous [3]. Therefore, the amount of such waste is quite small. But when this tiny amount is not infectious wastes are collected and resold handled properly, it gets mixed with the domestic solid waste, and the whole waste stream becomes potentially hazardous.

The agencies producing this medical/clinical waste are termed as generators, which include hospitals, clinics, diagnostic laboratories, medical research centres and colleges, centres for immunisation, dentist's chambers, veterinary, blood transfusion centres, residences using home-treatment, and similar other agencies. Small generators may produce less than 25 kgs of waste per month while big generators may produce several hundred or thousand kgs.

As the bio-hazardous components of the total medical waste poses potential threat to humans, animals, and the environment, their disposal should be strictly regulated. Non-bio-hazardous components can be disposed of as ordinary solid waste with less or no potential to infect humans or animals. The medical/clinical waste including sharps may also contain chemical carcinogens and or hazardous chemicals and radioactive materials, which are equally dangerous to human health.

Sharps constitute a special category of medical waste that include needles, syringes, lancets, scalpel blades, tubes, pipettes, glasses, instruments and tools, etc. used to puncture, cut or scrape body-parts, and or storing, testing or culturing bloods and other body fluids. They have sharp edges, corners, points or protuberances capable of punching or piercing through bags, containers and the human body during collection, transportation, and disposal. They can also punch or pierce through the body-parts of waste pickers, pedestrians, sportsman, and health conscious people practicing regular morning or evening walks.

Can we think of the risks involved in dumping medical waste in public places? The risks have equal potential for everyone. Just one prick by any of these indiscriminately disposed sharps may lead to the potential risk of transmitting the deadly HIV-AIDS virus and put a person in the so-called social dustbin for the rest of his or her lifetime and finally to the grave cursed, hated, and unlamented because of the traditional belief that the primary cause of this disease is some kind of sinful act.

Similarly, other non-sharp waste can also cause various deadly and infectious diseases from occupational or accidental contact with them. Therefore, continued negligence in disposing of these medical wastes can one-day bring about a catastrophic disaster if not taken care of today.

The largest generator of this waste is perhaps the Dhaka Medical College Hospital, where Medical Assistants (Ayas) collect contaminated saline bags, syringes, and needles, and carry them in plastic bags for selling to other healthcare facilities. The report also says, it's a business controlled by some union leaders of DMCH, surely under somebody's umbrella. Nobody seems to be aware of the fact that open dumping of medical waste and reuse of the contaminated sharps carry a potentially dangerous risk for the people and the environment.

The Daily Star, DMCH bought a new incinerator three years back and installed it in a building built at a cost of Tk 27 lakhs (cost of the incinerator must be much higher). Since then, the plant has remained almost inoperative as two out of its three trays went out of order and could not be repaired because of lack of funds. More interestingly, one of the operators was a bus helper and the other was an electrician without any training. There are many examples such as these where costly equipment purchased at public expense is unable to provide the desired service because of lack of maintenance, which is again because of lack of money.

Sanitation of medical waste usually means disinfecting and sterilising the waste, which destroys the micro-organisms and their spores through physical and chemical processes so as to convert them into biologically inert materials. In many countries the safe disposal of medical waste is very important and handled in a very professional manner. They have effective systems of tracking waste generators, and follow specified regulations for segregation, collection, treatment and disposal of medical waste. The staff and people are trained in the use of separate bins and bags for different types of medical waste. At the very generation point, the waste is segregated into bio-hazardous, non-bio-hazardous, sharps, toxins, pharmaceuticals, carcinogens and ordinary solid waste, etc. and stored in designated bags and bins with identification tags and or barcodes. This minimises the actual volume of potentially infectious or dangerous medical waste to almost one quarter and makes the disposal less costly and more effective.

Unfortunately, there is little effort in properly disposing hospital (biomedical) waste in Bangladesh. Hospital waste is generally disposed of in the same way as ordinary domestic waste.